PECS-PIFB Superior to Paravertebral Block for managing Pain after Modified Radical Mastectomy: Study

Written by Dr Monish Raut Published On 2025-03-21T21:00:41+05:30 | Updated On 22 March 2025 10:48 AM IST

PECS-PIFB Superior to Paravertebral Block for managing Pain after Modified Radical Mastectomy: Study

Recent study was conducted to compare the efficacy of two different nerve block techniques for postoperative pain management in patients undergoing modified radical mastectomy (MRM) surgeries. The traditional approach of thoracic paravertebral block (PVB) was compared with a combination of pectoral nerve block (Pecs) and pecto-intercostal fascial plane block (PIFB). The primary outcome of the study was the time to the first demand dose of rescue analgesic, with secondary outcomes including postoperative opioid consumption, pain scores at various time intervals, patient satisfaction scores, and block-related complications.

Randomized Controlled Trial Results

In the randomized controlled trial, fifty patients scheduled for MRM were assigned to receive either Pecs-PIFB block or PVB. The results indicated that patients who received the Pecs-PIFB block had a significantly longer median time to requiring rescue analgesia and lower 24-hour postoperative morphine consumption compared to those who received PVB. Additionally, patients in the Pecs-PIFB group reported better pain scores at 30 minutes and 1 hour post-surgery.

Extended Analgesia and Safety

The study highlighted that the combination of Pecs and PIFB block provided extended analgesia duration and reduced the need for postoperative opioids in MRM patients. Importantly, there were no significant differences in block-related complications between the two groups. The researchers recognized the complexities of breast innervation and the need for effective pain management strategies in breast surgeries.

Targeting Analysis

The Pecs-PIFB block targeted the anterior cutaneous branches of the intercostal nerves, known to supply the medial aspect of the breast, potentially explaining its improved analgesic efficacy compared to PVB. The study emphasized the importance of safer and effective analgesic techniques like Pecs-PIFB in minimizing postoperative pain and opioid consumption in MRM surgeries.

Study Limitations and Future Research

While the study had limitations such as the timing of block administration after general anesthesia and the lack of established drug dosages for PIFB, the robust methodology and comparison of recommended blocks by the PROSPECT guideline added strength to the findings. Future studies with larger sample sizes could further validate the benefits of Pecs-PIFB over PVB in enhancing postoperative pain management for MRM patients. In conclusion, the study supported Pecs-PIFB as a superior analgesic technique to PVB for MRM surgeries, potentially offering a safer and more effective alternative for postoperative pain control with reduced opioid consumption and improved patient outcomes.

Key Points

- The study compared the efficacy of Pecs-PIFB block versus thoracic paravertebral block (PVB) for postoperative pain management in modified radical mastectomy (MRM) surgeries.

- Patients receiving Pecs-PIFB block had a longer time to requiring rescue analgesia and lower postoperative morphine consumption compared to PVB recipients.

- Pecs-PIFB block demonstrated improved pain scores at 30 minutes and 1 hour post-surgery, indicating better pain management outcomes.

- The combination of Pecs and PIFB block provided extended analgesia duration, reduced opioid use, and showed no significant differences in block-related complications compared to PVB.

- Pecs-PIFB block targeted the anterior cutaneous branches of intercostal nerves, explaining its enhanced efficacy in providing pain relief in MRM surgeries compared to PVB.

- Although the study had limitations, future research with larger sample sizes could further validate Pecs-PIFB as a safer and more effective alternative to PVB for postoperative pain control in MRM surgeries.

Reference –

Adarsh M Sheshagiri et al. (2025). Pectoral Nerve Block And Pecto-Intercostal Fascial Block Versus Thoracic Paravertebral Block For Postoperative Analgesia In Modified Radical Mastectomy:A Randomised Controlled Trial. *Indian Journal Of Anaesthesia*. https://doi.org/10.4103/ija.ija_734_24

Modified radical mastectomymorphinepostoperative painpectoral nerveparavertebral blockPecto-intercostal fascial planePIFBpectoral nerve block

Dr Monish Raut

MBBS, MD (Anaesthesiology), FNB (Cardiac Anaesthesiology)

Dr Monish Raut is a practicing Cardiac Anesthesiologist. He completed his MBBS at Government Medical College, Nagpur, and pursued his MD in Anesthesiology at BJ Medical College, Pune. Further specializing in Cardiac Anesthesiology, Dr Raut earned his FNB in Cardiac Anesthesiology from Sir Ganga Ram Hospital, Delhi.